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LIONESS CONVERSION PROGRAM

Effective January 1, 1996 the Lions Clubs International Board of Directors approved a
Lioness Conversion Program granting Lions, who were former Lionesses, their past
Lioness years of service when they become Lions.

LIONESS CONVERSION HISTORICAL RECORD

*First
Name:

Middle
Name:

*Last
Name:

Maiden
Name:

*Address:

*City:

*State:

*Postal Code:

*Country:

*Current Lions club name:

*District #:

*Club #:

*Member # in club:

*Original Lioness Join Date:

Month:

Year:

*Original Join Date in a Lions Club:

Month:

Year:

*Years of Service to be credited to my Lions record:

For Internal
Use Only

Gender:

Each Lioness requesting their service credit be transferred to a Lions club is asked to complete this form either online or to print out a copy and mail or fax it in. A separate paper version of this form is also on the LCI Web site.

Clubs submitting this form online should also submit a WMMR. Clubs submitting the paper version of this form should attach the appropriate MMR before mailing.